Leg length difference after TKR!

Posted by Mamie @mamie, May 12, 2018

My sister, who also has chronic venous insufficiency, had a total knee replacement at the end of February. Has been doing exercises, going to PT, but after more pains, her PT suggest she start using a cane. Pain in legs and lower back. Finally PT measured her and said her “new knee” leg is 1.6 inches!!! longer than the other one. She is devastated that she is now in worse pain than she was before TKR. She was told to build up the shoe of her shorter leg and find someone to add to the bottom of the shoe as well. Now she can’t walk around barefoot anymore but has to put on shoes to ease the pain even a little. What can she do? Any suggestions?

Liked by EES1, nlembeck

@ellerbracke

Update: custom orthotics helped with gait and hip issues. After initial acclimation period I found that while wearing the inserts mostly for extended outdoor activities the benefit lasts all day, even if I prefer to walk barefoot in the house. Feels good to be able to take full, easy strides again. Regarding the other issue – still daily twinges in the TKR knee. Usually not raising to the level of pain, but definitely still not like the remaining good one. But, much to my surprise, I’m halfway to getting over my aggravation with the clicking noise and feeling. Perhaps my hearing is going as well? Just kidding. All in all, things are pretty good right now. Can always be better, of course, but could also have been much, much worse.

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@ellerbracke I am very happy to read your post. You sound so positive and optimistic. That's great that the orthotics are helping.

I try to keep in mind too, when things are not going well, they could always be worse. I am very grateful for how fortunate I am overall.
JK

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@ellerbracke

Update: custom orthotics helped with gait and hip issues. After initial acclimation period I found that while wearing the inserts mostly for extended outdoor activities the benefit lasts all day, even if I prefer to walk barefoot in the house. Feels good to be able to take full, easy strides again. Regarding the other issue – still daily twinges in the TKR knee. Usually not raising to the level of pain, but definitely still not like the remaining good one. But, much to my surprise, I’m halfway to getting over my aggravation with the clicking noise and feeling. Perhaps my hearing is going as well? Just kidding. All in all, things are pretty good right now. Can always be better, of course, but could also have been much, much worse.

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@ellerbracke – I'm so happy to hear your positive report. It sounds like things aren't perfect… but not terrible either. And most importantly, it sounds as if things are better compared to a few months ago. Sometimes it's difficult to appreciate these incremental improvements. Hoping things continue to get better. Please keep updating us!

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That was my greatest fear before my surgery! Mine both turned out ok, thankfully. Is it the doctor's fault?

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@mamie

Hi @lturn9. I've only been visiting the forum on occasion but saw your post about your situation. Have you considered talking to anyone about bone lengthening to regrow some of the bone lost? I was looking at the website for the Hospital for Special Surgery, which apparently is the top site for orthopedic surgery in the U.S. and saw this information: https://www.hss.edu/limblengthening-about.asp
Perhaps you could ask your surgeon about it or find someone there to communicate with you to see if that is a possibility for your situation. Or perhaps someone at Mayo is familiar with the process. Best wishes!

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Thanks! Great idea/ I will look into that. Thanks again!

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@mamie

Thanks, @gailfaith, for your comments. I am happy your bilateral TKRs went well and saddened that you now have to use a walker after your accident.

Yes, my sister, who is in her early 60s, is having back problems because of the great difference now between the length of her legs. Is anyone aware of what leg length discrepancy (LLD) is below what could be considered the standard of care in a TKR? I've searched online for those who have had TKR and no one seems to come close to 1.6 inches. Almost all seem to have a half inch, with 1 inch seeming to be the largest LLD.

It's unfortunate that doctors don't seem to be held accountable for their mess-ups. Possible problems are never mentioned in all of the TKR marketing, nor did her doctor mention it when she made the customary one-consultation appointment to see if she needed a TKR.

Apparently you can't even build a shoe up that high with custom orthotics and why should she have to seek out and pay for custom shoes for life? She is devastated. If anyone has any information on what she could do to help herself, please post. Thanks.

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Hi Mamie I am just curious how your sister is doing today, I am three years post knee replacement surgery and have major leg length discrepancy and still have major pain. By back pain is also getting worse. I know this is all due to my leg length discrepancy but nobody believes me. Has your sister found any relief?
Hope to hear from you,
Nick

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@mamie

Thanks, @gailfaith, for your comments. I am happy your bilateral TKRs went well and saddened that you now have to use a walker after your accident.

Yes, my sister, who is in her early 60s, is having back problems because of the great difference now between the length of her legs. Is anyone aware of what leg length discrepancy (LLD) is below what could be considered the standard of care in a TKR? I've searched online for those who have had TKR and no one seems to come close to 1.6 inches. Almost all seem to have a half inch, with 1 inch seeming to be the largest LLD.

It's unfortunate that doctors don't seem to be held accountable for their mess-ups. Possible problems are never mentioned in all of the TKR marketing, nor did her doctor mention it when she made the customary one-consultation appointment to see if she needed a TKR.

Apparently you can't even build a shoe up that high with custom orthotics and why should she have to seek out and pay for custom shoes for life? She is devastated. If anyone has any information on what she could do to help herself, please post. Thanks.

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I have the exact same problem! I came out of surgery in so much pain and even had to stay an extra day due to pain management. I kept telling them my leg was to long and it felt stretched. They just told me that it was impossible to come out of a TKR with a longer leg. One surgeon ever said that if they would have done that I would be in a lot of Pain because you can’t stretch tendons that long. I’m now 3 year post op and the pain is 24/7 and I am still taking oxy for the pain. Yep 3 year of oxy just do I can walk. I’m about ready to have them just remove the leg to stop this pain.
I’d love to hear how your sister is doing.

Thanks for listening
Nick

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Sorry to hear you are having so many issues following TKR. Unfortunately, people don't understand what it's like to walk with one leg shorter than the other – it's like stepping in a hole with one leg and it throws the hips out of alignment when then pushes the back out of alignment. Everything is connected. A prosthetic shoe maker "may" be able to fit you with the proper shoe to help the shortened leg. I say "may" because the ones I have seen usually just asked what I wanted and said OK. They're supposed to provide their professional opinion, not the other way around. Anyway, I will pray for you.

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@lturn9

Sorry to hear you are having so many issues following TKR. Unfortunately, people don't understand what it's like to walk with one leg shorter than the other – it's like stepping in a hole with one leg and it throws the hips out of alignment when then pushes the back out of alignment. Everything is connected. A prosthetic shoe maker "may" be able to fit you with the proper shoe to help the shortened leg. I say "may" because the ones I have seen usually just asked what I wanted and said OK. They're supposed to provide their professional opinion, not the other way around. Anyway, I will pray for you.

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@lturn9 @nlembeck There generally are shoe stores that specialize in that type of thing. If you see a podiatrist they can probably recommend one. There is one not far from me in southern NH where I purchase shoes frequently, and they also do shoes for problems. My sister went there at the recommendation of a podiatrist when she was having a problem. If there's one in southern NH there must be one pretty much everywhere.
JK

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@lturn9

Thank you for the suggestions and kind thoughts. re: "Diabetic Neuropathy" Nope, I am not diabetic (Thank the Lord!) and my Neuropathy is Ideopathic (Unknown origin) and could have come from an infection in my past or some other incident. re: Your Sister's Hip, There must be a definitive test to determine if her Hip is actually bad? I hope she doesn't have it done then discover it was not necessary! But I'm sure the Doc would say, "Sorry" and refund the money! Yeah, right. Sorry, I've gotten cynical. ;-\ I just realized you posted last Fall so this caution reached you sister too late. I hope all went well?

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Hi, I have the same issue. Following my left TKR in 2013 my LLD was 2.7 cm. After I had my right leg done it is now down to about 1-1.5 cm. MY dr told me "most people wouldn't notice this". I do!! Any ideas on how I can find someone who can fit me with a good corrective orthotic?
thanks

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Hello, I was just told that there is no way to get them to match during surgery and was told to go to the podiatrist to get fitted. I haven't done that yet since I still have numbness and tingling in that foot. All I know is that it is throwing my back out since walking lopsided. Funny how one thing can affect so many different parts of your body.
Good luck in finding help!

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@rah2435

Hi, I have the same issue. Following my left TKR in 2013 my LLD was 2.7 cm. After I had my right leg done it is now down to about 1-1.5 cm. MY dr told me "most people wouldn't notice this". I do!! Any ideas on how I can find someone who can fit me with a good corrective orthotic?
thanks

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@rah2435 : can only say how it worked for me. After several hip issues, once knee was fine, my physical therapist measured my leg length – actually, what he measured was where the heels align, so whether it was bone length, muscle mis-alingment, spine issues – the result was that the heels did not line up. Probably caused by TKR, since I never had any issues like that before.
Anyhow, PT took casts of my feet, and specified as to how much thicker the left (non-TKR) side orthotic insert should be made. Worked out for me. But difference in leg length was only maybe 1/2”, but with history of back pain and sciatica, that’s all that was needed to really mess me up.

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